Impact of routine use of intraoperative transesophageal echocardiography during cardiac surgery

Purpose: To determine the relative impact of each category-based TEE indica tion according to the ASA guidelines. Methods: In 851 patients undergoing cardiac surgery, TEE clinical indicatio ns were classified as category I or II according to the ASA guidelines. Cat egory I indications are patients in which TEE is considered useful and cate gory II are those where TEE is potentially useful but indications are less clear. All TEE examinations were reviewed by two anesthesiologists with adv anced training in TEE. For each patient, the clinical impact of TEE in the clinical management was assessed using five criteria: I) change of medical therapy; 2) change in the surgical procedure; 3) confirmation of a suspecte d diagnosis; 4) positioning of an intravascular device, and 5) substitute t o a pulmonary artery catheter (PAC). Results: TEE had greater utility in category I than in category II Indicati ons (15/53 (28%) vs 110/798 (14%) respectively) (P < 0.01). The nature of t he clinical impact was as follows: modification of medical therapy in 67/12 5 (53%), modification of planned surgical intervention in 38/125 (30%) conf irmation of a diagnosis in 34/125 (27%). The impact on therapy was higher i n complex surgical procedures (39%) than in valvular replacement(19%) (P < 0.01)and coronary artery bypass surgery(10%) (P < 0.001). Conclusions: Our findings validate the usefulness of the ASA practice guide lines demonstrating a greater impact of TEE on clinical management for cate gory I indications than for category II. TEE also had a greater clinical im pact in complex surgical procedures and in valvular replacement.